title: Early stage follicular lymphoma: what is the clinical impact of the first-line treatment strategy?
abstract: BACKGROUND
  Less than 20% of patients with follicular lymphoma (FL) present with Ann Arbor Stage I or II disease at diagnosis. Numerous therapeutic options exist, however radiation therapy is considered the standard of care for early-stage disease based on single-institution or retrospective series. Our aim was to revisit the outcome of patients with localized FL in the rituximab era.
  
  
  METHODS
  We analyzed the characteristics and outcomes of 145 early-stage FL patients, who were retrospectively divided into six groups according to their initial treatment: watchful waiting (WW), chemotherapy alone (CT), radiotherapy alone (RT), combined radiotherapy and chemotherapy (RT-CT), rituximab alone (Ri), and immunochemotherapy (Ri-CT).
  
  
  RESULTS
  Of the 145 patients, 84 (57.9%) had stage I disease and 61 (42.1%) stage II. The complete response (CR) rate varied from 57% for the Ri group to 95% for the RT-CT group. Overall survival (OS) at 7.5 y of patients treated after 2000 was better than that of those treated prior to 2000. OS did not significantly differ from one treatment to another. In contrast, a significant difference was found for progression-free survival (PFS) at 7.5 y, which favored Ri-CT (60%) therapy versus the others (p=0.00135).
  
  
  CONCLUSIONS
  Delayed therapy initiation was associated with a similar OS than that observed in patients receiving immediate intervention. The "watchful waiting" strategy may thus be proposed as first-line therapy, similar to stage III and IV FL patients with a low tumor burden. However, when treatment is required, immunochemotherapy appears to be the best option.
authors.affiliation: Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France. annesophie.michallet@voila.fr
authors.forename: Anne-Sophie A S
authors.initials: AS
authors.lastname: Michallet
authors.forename: Laure L
authors.initials: LL
authors.lastname: Lebras
authors.forename: Deborah D
authors.initials: DD
authors.lastname: Bauwens
authors.forename: Fadhela F
authors.initials: FF
authors.lastname: Bouafia-Sauvy
authors.forename: Françoise F
authors.initials: FF
authors.lastname: Berger
authors.forename: Christelle C
authors.initials: CC
authors.lastname: Tychyj-Pinel
authors.forename: Anne A
authors.initials: AA
authors.lastname: D'Hombres
authors.forename: Gilles G
authors.initials: GG
authors.lastname: Salles
authors.forename: Bertrand B
authors.initials: BB
authors.lastname: Coiffier
mesh_terms: D000368:Aged; D059248:Chemoradiotherapy; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007167:Immunotherapy; D008224:Lymphoma, Follicular / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome